{
"Npi": {
"NPI": "1790915221",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DYNAMIC MRI AND 3D CT CSP",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PMB 336",
"SecondLineMailingAddress": "405 AVE ESMERALDA STE 2",
"MailingAddressCityName": "GUAYNABO",
"MailingAddressStateName": "PR",
"MailingAddressPostalCode": "00969-4457",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "787-272-3182",
"MailingAddressFaxNumber": "787-708-2588",
"FirstLinePracticeLocationAddress": "6 CALLE CARAZO",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GUAYNABO",
"PracticeLocationAddressStateName": "PR",
"PracticeLocationAddressPostalCode": "00969-5613",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "787-272-0668",
"PracticeLocationAddressFaxNumber": "787-708-2588",
"EnumerationDate": "07/17/2009",
"LastUpdateDate": "10/13/2011",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CORDOVES",
"AuthorizedOfficialFirstName": "NIDZA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "ADMINISTRATOR",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "787-272-3182",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QR0200X",
"TaxonomyName": "Radiology Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}